Current Neurology and Neuroscience Reports最新文献

Purpose of review: Effective control of blood pressure (BP) is potentially a critical determinant in making a successful recovery from acute ischemic stroke. BP is often elevated after the onset of this critical illness, and it is related to both the severity of the ischemic injury and subsequent changes in cerebral perfusion and collateral blood flow. However, recent studies have challenged longstanding assumptions over the safety and efficacy of BP lowering in being able to reduce the risk of reperfusion injury in acute ischemic stroke. This review synthesizes contemporary evidence and discusses the evolving landscape of BP management in acute ischemic stroke.

Recent findings: Three prehospital ambulance-initiated trials of early BP lowering in patients with undifferentiated stroke have shown neutral or adverse effects, while the results of multiple trials of in-hospital management BP lowering in patients who have received successful reperfusion therapy for acute ischemic stroke due to large-vessel occlusion highlight the risks of over-aggressive treatment. Despite considerable research effort, the optimal BP management strategy in acute ischemic stroke remains uncertain, although avoiding excessive reductions appears critical.

Purpose of review: Attention-deficit/hyperactivity disorder is a common neurodevelopmental disorder characterized by impairing levels of inattention, hyperactivity and impulsivity that adversely impact functioning across social, academic/occupational and home settings. While the name of the disorder implies obvious difficulties in attention, research has struggled to consistently identify a precise neurocognitive marker. This article aims to characterize the functioning of selective visual attention in ADHD by reviewing previous studies that compare individuals with ADHD and healthy controls at the behavioral and neural levels using single-frame visual search tasks.

Recent findings: Past research indicates both bottom-up (stimulus-driven) and top-down (goal-driven) attention across both time and space are likely affected in ADHD. However, more research is needed to illuminate the specific mechanisms involved. Ultimately, this narrative review aims to highlight the importance of studying selective visual attention in ADHD to explain the heterogeneous symptoms and impairments of this complex disorder, as well as to build a stronger bridge between the high-level behaviors of ADHD and their underlying neurobiological mechanisms.

Purpose of review: Neuromodulation provides additional treatment options for patients with drug-resistant epilepsy who are not candidates or unwilling to undergo resective or ablative surgery. However, our current knowledge on the safety and efficacy of different neuromodulating devices during pregnancy is limited. This article reviews recent research on pregnancy outcomes in epilepsy patients treated with vagus nerve stimulation (VNS), deep brain stimulation (DBS), or responsive neurostimulation (RNS).

Recent findings: Currently available information about pregnancy outcomes in epilepsy patients with neuromodulating devices all comes from cases series or case reports. Randomized control trials or prospective observational studies are lacking in this patient population. The overall sample size is too small to draw conclusions on the safety of these neuromodulating devices in pregnancy and maternal outcomes including obstetric complications. There is no clear sign of device-related teratogenicity. Further research should be directed at establishing a pregnancy registry and conducting multi-center prospective studies to track pregnancy outcomes in epilepsy patients with various neuromodulating devices.

Purpose of review: Covert consciousness, including cognitive motor dissociation (CMD), occurs in clinically unresponsive patients with brain injury who can willfully modulate their brain activity to comply with motor imagery commands as revealed by functional magnetic resonance imaging, EEG or other technologies. In 2024, the Curing Coma Campaign conducted a gap analysis of the field of covert consciousness and CMD. This article discusses the achievements that have been made in the field since then.

Recent findings: Three major recent achievements include epidemiological data that CMD occurs in up to 25% of unresponsive brain injury patients, the development of convenient tools for detecting CMD at the bedside, and CMD as a biomarker of cerebral reserves that may possibly be exploited pharmacologically for prognostication and rehabilitation. Although many questions remain, recent findings have paved the way for the implementation of CMD screening in clinical routine, also in resource-poor settings, for better prognostication after brain injury and possibly for therapeutic purposes.

Purpose of review: Eye pain is a common but diagnostically complex symptom. The underlying etiologies span neurologic, ophthalmologic, and systemic conditions that range from benign to vision- or life-threatening. This review aims to provide a neurologist-oriented approach to the differential diagnosis of eye pain, emphasizing clinical reasoning and red flag identification.

Recent findings: Ocular inflammation and surface disorders are commonly diagnosed etiologies for eye pain but neurologic disorders including primary headaches may be underrecognized sources of eye pain. Clinical clues like the pain description and location, patterns of visual disturbances, and other associated symptoms can guide diagnosis. Exam clues like optic disc edema, cranial nerve abnormalities, red eye pattern, ocular bruit, and intraocular pressure can guide localization and referral urgency. Integration of targeted history, key physical exam findings, and judicious use of investigations are critical for identifying vision- or life-threatening pathology. Using a focused history with targeted neurologic and ophthalmologic examinations, neurologists will be able to choose appropriate investigations and identify when urgent ophthalmology referral is required. This review outlines a systematic, symptom-based approach to eye pain so that neurologists can identify urgent conditions, improve diagnostic efficiency, and collaborate effectively with ophthalmology.

Purpose of review: To evaluate the effectiveness of rehabilitation therapies for managing symptoms of sleep and autonomic dysfunction (cardiovascular, gastrointestinal, urinary and sexual) in Parkinson's disease (PD). The narrative review focuses on recent data drawn from clinical trials, particularly randomized controlled trials, to assess these therapies and the overall quality of the evidence.

Recent findings: Resistance training and aerobic exercises can improve sleep quality in PD. Resistance and aerobic exercises, along with abdominal binders, may help alleviate orthostatic hypotension, though the quality of evidence is not high. Interventions such as expiratory muscle strength training, sensorimotor training, and video-assisted swallowing therapy are beneficial for dysphagia. Pelvic floor muscle training combined with behavioral therapy can potentially mitigate urgency and urge incontinence. Many rehab-based strategies though promising lack sufficient evidence for implementation into clinical practice. The current evidence supports their role in addressing sleep disturbances, orthostatic hypotension and dysphagia. However, the evidence for their effectiveness in treating gastroparesis, constipation, and urinary and sexual dysfunction remains limited.

Purpose of review: Definitive diagnosis of multiple sclerosis (MS) requires exclusion of other central nervous system (CNS) disorders sharing similar clinical, pathological and radiological features. In this review we discuss some relatively uncommon disorders with special emphasis on their differentiation from MS clinically and radiologically. While most conditions have a demyelinating pathology, a few very important mimics may have a non-demyelinating pathology to merit some discussion.

Recent findings: Two major areas of diagnostic advances have been made in recent times, the recognition of neuromyelitis optica spectrum disorder (NMOSD), and the myelin oligodendrocyte antibody mediated disorder (MOGAD). These two entities are mediated by completely different antibodies detectable in peripheral blood samples by enzyme-linked immunosorbent assay (ELISA) or cell-based assays and produce clinical disorders could be differentiated from MS by their clinical features, disease course, prognosis, and imaging features. NMOSD is a rare CNS autoimmune disease that predominantly targets the spinal cord, optic nerves and brainstem. In sixty to eighty% of cases of NMOSD, optic neuritis (ON) and/or longitudinally extensive transverse myelitis (LETM) result in blindness and paralysis. In NMOSD these are associated with a serological antibody to aquaporin-4 (AQP4). AQP4 is a water channel protein found in many organs, but in the CNS, AQP4 is expressed in a perivascular distribution on astrocytic foot processes around blood vessels and the glia limitans (glymphatic). Comparative studies of AQP4-seropositive and AQP4- seronegative NMOSD cohorts note that some of the seronegative NMOSD cases tend to differ from the seropositive cases in several aspects: bilateral optic neuritis, simultaneous optic neuritis and transverse myelitis, younger age at onset, and an apparently monophasic course. This prompted search for putative antibodies other than AQP4. MOG antibody disease is a CNS autoimmune disease associated with a serological antibody against myelin oligodendrocyte glycoprotein (MDG). MOG is a glycoprotein expressed on the outer membrane of myelin and solely found within the CNS, including the brain, optic nerves and spinal cord. Clinically, the disease resembles NMOSD in its predilection for relapses of optic neuritis and transverse myelitis. In addition, acute disseminated encephalomyelitis (ADEM) is a well-recognized phenotype of MOG antibody disease in children. About 42% of NMOSD patients who test seronegative for the AQP4 antibody test positive for MOG antibodies. MOG antibody disease has thus recently emerged as a distinct entity in a sizable portion of the patient population diagnosed with NMOSD or even MS. The second field where significant progress has been made is the recently modified McDonald criteria proposed at the ECTRIMS (European Committee (2024) for Treatment and Research in Multiple Sclerosis) which i

Purpose of this review: This review explores the complex relationship between cancer and vascular disease. It aims to synthesize current evidence on the epidemiology, mechanisms, management, and outcomes of ischemic stroke, cerebral venous sinus thrombosis (CVST), venous thromboembolism (VTE) in brain tumor patients, and intracranial hemorrhage (ICH), while highlighting the cerebrovascular risks of systemic cancer therapies.

Recent findings: Recent studies reveal that cancer patients are at increased risk for ischemic stroke, often from cancer-specific mechanisms such as hypercoagulability, non-bacterial thrombotic endocarditis, and tumor embolism. VTE is increasingly recognized in patients with primary brain tumors. Emerging data support the safety of direct oral anticoagulants over low-molecular weight heparin in selected patients with brain tumors. Cancer treatments-including immune checkpoint inhibitors (ICIs), hormonal therapies, and radiation-contribute to cerebrovascular risk. Vascular complications are underrecognized yet significant contributors to morbidity and mortality in cancer patients. Multidisciplinary strategies, personalized risk stratification, and targeted research are critical to improving outcomes in this vulnerable population.

Purpose of review: Social cognition, especially theory of mind (ToM), is often impaired in clinical populations including epilepsy, with serious consequences for quality of life. This review synthesizes evidence from clinical assessments, neuroimaging, and intracranial recording techniques to examine how social cognitive processes are represented in the human brain and how they may be disrupted in epilepsy. Emphasis is placed on the emerging contributions of intracranial electroencephalography (iEEG) and intracranial electrical stimulation (iES) to this field.

Recent findings: While the literature using iEEG/iES to investigate social cognition remains limited, recent studies have begun to map the spatiotemporal and causal underpinnings of ToM and related functions. This work complements behavioral and fMRI findings and suggests avenues for translational research. Intracranial techniques represent a promising tool for advancing social cognitive neuroscience. Integrating this approach with clinical data and established behavioral paradigms can enhance our understanding of social cognition and improve care for populations with focal epilepsy.

Purpose of review: This article reviews recent clinical updates and research on the evaluation and management of patients with peripheral neuropathy in association with monoclonal gammopathies.

Recent findings: Recent studies have elucidated pathogenic mechanisms of IgM paraprotein associated neuropathies, including nodal and paranodal targets and complement mediated processes, suggesting novel therapeutic targets. New chemotherapeutic regimens have improved outcomes and neurotoxic side effect profiles in the treatment of patients with light chain (AL) amyloidosis and POEMS syndrome. Establishing when a monoclonal gammopathy is causative of a peripheral neuropathy remains a clinical challenge. New therapeutic drugs for treatment of IgM paraprotein associated neuropathies show promise. Identifying AL amyloidosis and POEMS early in patients presenting with neuropathy are important. Clinical phenotyping and antibody testing are critical to evaluating patients with paraproteins and peripheral neuropathy.